Cardiovascular complications related to cocaine use: case report

BACKGROUND AND OBJECTIVES: Cocaine is the most commonly used illicit drug and its acute and chronic effects are related to a variety of physiological changes, mainly in the cardiovascular system. This study is a case report of a patient with cardiomyopathy related to cocaine use. CASE REPORT: A 19 year old men, who has been using cocaine and crack since 15 years old, was admitted to the emergency department (ED) in February 2006 with progressive dyspnea during minimal efforts and bloody expectoration. During the physical exam it was observed legs edema, jugular stasis and dyspnea at rest. The echocardiogram demonstrated left ventricular hypocinesia, a 17 mm ventricular thrombus and a 12% ejection fraction. A bleeding from the left upper lobe was identified during a pulmonary bronchoscopy which was treated with arterial embolization. After 48h of the procedure, the patient was asymptomatic and an antithrombotic treatment with warfarin and enoxaparin was started. No obstruction was found at the cineangiography and the patient was discharged after clinical improvement. The patient was admitted again to the intensive care unit in July with intense chest pain and dyspnea at rest. A new cineangiography was performed and it was observed occlusion in the anterior descendent coronary artery. CONCLUSIONS: The cocaine acute effects are commonly seen at the ED but the chronic effects, as the cardiovascular manifestations, can take longer to be correlated as a side effect of cocaine use. Its prolonged use is related to left ventricular systolic dysfunction due to hypertrophy or myocardial dilation, atherosclerosis, arrhythmias, myocyte apoptosis and sympathetic damage.JUSTIFICATIVA E OBJETIVOS: A cocaína é uma droga ilícita amplamente utilizada e o seu uso tem sido associado a efeitos decorrentes da toxicidade aguda e crônica em praticamente todos os órgãos, particularmente no sistema cardiovascular. Este artigo visou descrever um caso de cardiomiopatia em paciente jovem usuário crônico de cocaína. RELATO DO CASO: Paciente do sexo masculino, 19 anos, usuário de cocaína por inalação e crack desde os 15 anos de idade. Foi internado em fevereiro de 2006 devido a dispnéia progressiva aos mínimos esforços e expectoração sanguinolenta. Ao exame físico apresentava edema nos membros inferiores, estase jugular e dispnéia em repouso. Foram observados no ecocardiograma: dilatação das quatro câmaras cardíacas, com hipocinesia difusa de ventrículo esquerdo (VE), trombo mural em VE de 17 mm e fração de ejeção de 12%. Realizada broncoscopia pulmonar que identificou sangramento em língula ativo, tratado com embolização. Após 48h do procedimento, o paciente manteve-se assintomático e sem expectoração sanguinolenta. Iniciado tratamento antitrombótico com warfarina e enoxaparina. A cineangiocoronariografia não evidenciou lesões obstrutivas e o paciente recebeu alta após melhora clínica. Re-internado em julho de 2006 com dor precordial de forte intensidade e dispnéia de repouso. Nova cineangiocoronariografia evidenciou oclusão de terço médio da artéria descendente anterior. CONCLUSÕES: Os efeitos agudos da cocaína freqüentemente motivam atendimento de emergência. Já as suas manifestações crônicas, como as doenças cardiovasculares, podem produzir alterações de difícil correlação futura ao seu consumo prévio. O uso prolongado da cocaína está relacionado à alteração da função sistólica ventricular esquerda por hipertrofia ou dilatação miocárdica, aterosclerose, disritmias cardíacas, apoptose de cardiomiócitos e lesão simpática.UNIFESPUniversidade São FranciscoUNIFESPSciEL

Anaplasma marginale infection in cattle from southwestern Amazonia.

study provides the first epidemiological data regarding infection by Anaplasma marginale in cattle reared in south-western Brazilian Amazonia. One simple procedure was adapted for the extraction of DNA from blood clots collected in seven microregions of Rondônia State and two mesoregions of Acre State. PCR method was used to asses the frequency of A. marginale infections in 4 to12-month-old cattle. The cattle infection was investigated by polymerase chain reaction (PCR) using the specific primer ?msp5? for A. marginale. The DNA amplifications revealed that the mean frequency of A. marginale infection was 98.6% (1,627/1,650) in samples from Rondonia, and 92.87% (208/225) in samples from Acre. The high frequency of A. marginale infections in 4 to 12- month-old cattle indicate a situation of enzootic stability in the studied areas and are comparable to those detected by immunodiagnosis in different endemic regions in Brazil. The DNA extraction of clotted blood method described here can be used for epidemiological studies on anaplasmosis and other bovine hemoparasites

Characterization of microclimate and turbulent fluxes at a Mediterranean kiwi orchard covered with hail-protection net

Screens and covers are increasingly used to protect crops from pests and extreme meteorological events. Their use affects plant microclimate and physiological responses as well, but this is only partly understood, particularly when considering the interaction among the cover and the training system. This study focuses on the microclimatic effects of the use of a hail protection net and an horizontal (pergola) kiwifruit canopy. The system splits the orchard environment in three distinct layers, determining a shaded understory, a space comprised between the canopy and the net, and the atmosphere above the net. To accent the effects, we considered a high-water demanding crop-kiwifruit, in an environment characterized by high evaporative demand (Bernalda, southern Italy).Three full eddy covariance and radiative balance equipment were used to assess fluxes (carbon dioxide, water vapor, and sensible heat) in the three layers and monitor meteorological variables (air temperature and relative humidity, wind, upward and downward short and long wave radiation, carbon dioxide and water vapor concentrations). Data from a typical clear-sky summer day are considered in this paper.While the net strongly reduced wind speed, it had a modest impact on all other variables. Conversely, the tick canopy layer had a major impact on all variables, determining a highly shaded, cooler and more humid understory, with very light wind. Nevertheless, the combination of high relative humidity and presence of the net was able to reduce the net loss of longwave radiation from the canopy during night, mitigating its cooling under these conditions.The reduction in wind speed and the increase in incoming longwave radiation around the crop, observed at night time, indicate potential valuable mechanisms that may be exploited to decrease water needs and prevent late frosts in the context of climate change, where extreme climatic events are more frequent and crop water requirements continue to increase

Phloroglucinol is Effective for in vitro Growth and Multiplication of Musa accuminata Cv. Grand Naine Shoots and Roots

Despite being a major staple food in the world, banana production in the United States is still limited, with about 500 acres under cultivation. Micropropagation has been an effective method for the large-scale production of bananas to meet both domestic and international markets. However, the efficiency of micropropagation protocols depends on several factors, particularly on the types, combinations, and levels of plant growth regulators used in the culture media. Phloroglucinol is a growth regulator that acts synergistically with auxins and cytokinins. The use of phloroglucinol for the production and development of in vitro plantlets of Musa spp. cv. Grande Naine were investigated. Multiplication and elongation of shoots and roots in vitro was enhanced by the addition of 200 μM phloroglucinol to MS medium, as compared to the control with 13.2 μM BA. Higher concentrations (400 to 1000 μM phloroglucinol) resulted in reduced growth and development of shoots and roots in vitro

Circulating mediators of inflammation and immune activation in AIDS-related non-Hodgkin lymphoma

Background: Non-Hodgkin lymphoma (NHL) is the most common AIDS-related malignancy in developed countries. An elevated risk of developing NHL persists among HIV-infected individuals in comparison to the general population despite the advent of effective antiretroviral therapy. The mechanisms underlying the development of AIDS-related NHL (A-NHL) are not fully understood, but likely involve persistent B-cell activation and inflammation. Methods: This was a nested case-control study within the ongoing prospective Multicenter AIDS Cohort Study (MACS). Cases included 47 HIV-positive male subjects diagnosed with high-grade B-cell NHL. Controls were matched to each case from among participating HIV-positive males who did not develop any malignancy. Matching criteria included time HIV+ or since AIDS diagnosis, age, race and CD4+ cell count. Sera were tested for 161 serum biomarkers using multiplexed beadbased immunoassays. Results: A subset of 17 biomarkers, including cytokines, chemokines, acute phase proteins, tissue remodeling agents and bone metabolic mediators was identified to be significantly altered in A-NHL cases in comparison to controls. Many of the biomarkers included in this subset were positively correlated with HIV viral load. A pathway analysis of our results revealed an extensive network of interactions between current and previously identified biomarkers. Conclusions: These findings support the current hypothesis that A-NHL develops in the context of persistent immune stimulation and inflammation. Further analysis of the biomarkers identified in this report should enhance our ability to diagnose, monitor and treat this disease. © 2014 Nolen et al

Induction of antigen-specific tolerance through hematopoietic stem cell-mediated gene therapy: the future for therapy of autoimmune disease?

Based on the principle that immune ablation followed by HSC-mediated recovery purges disease-causing leukocytes to interrupt autoimmune disease progression, hematopoietic stem cell transplantation (HSCT) has been increasingly used as a treatment for severe autoimmune diseases. Despite clinically-relevant outcomes, HSCT is associated with serious iatrogenic risks and is suitable only for the most serious and intractable diseases. A further limitation of autologous HSCT is that relapse rates can be high, suggesting disease-causing leukocytes are incompletely purged or the environmental and genetic determinants that drive disease remain active. Incorporation of antigen-specific tolerance approaches that synergise with autologous HSCT could reduce or prevent relapse. Further, by reducing the requirement for highly toxic immune-ablation and instead relying on antigen-specific tolerance, the clinical utility of HSCT could be significantly diversified. Substantial progress has been made exploring HSCT-mediated induction of antigen-specific tolerance in animal models but studies have focussed on primarily on prevention of autoimmune diseases. However, as diagnosis of autoimmune disease is often not made until autoimmune disease is well developed and populations of autoantigen-specific pathogenic effector and memory T cells have become well established, immunotherapies must be developed to address effector and memory T-cell responses which have traditionally been considered the key impediment to immunotherapy. Here, focusing on T-cell mediated autoimmune diseases we review progress made in antigen-specific immunotherapy using HSCT-mediated approaches, induction of tolerance in effector and memory T cells and the challenges for progression and clinical application of antigen-specific ‘tolerogenic’ HSCT therapy

Eficácia de um sistema de fornecimento de micronutrientes em plantas de jatropha está relacionado com incrementos na fotossíntese, troca gasosa e alocação de biomassa

This study aimed at comparing the growth and physiological changes in Jatropha curcas L. (jatropha or physic nut) young plants fertilized or not with a commercial product based on a micronutrient delivery system (MDS), under different doses of NPK. Measurements of growth, chlorophyll content, and leaf gas exchange were performed in the greenhouse, where plants were arranged in a split-split plot design. Plants were grown for 120 days in 3.9 L pots containing local soil, with or without MDS (main plot), combined with NPK doses (0; 1.8; 4.7 and 7.4 g L-1) in subplots. Dose-response curves showed that most variables were positively responsive to NPK doses in plants growing without MDS, whereas slight responses or even opposite behavior was observed in MDS-fertilized plants. MDS application under low NPK doses resulted in higher biomass allocation in leaves and roots, increases in number of leaves and chlorophyll content, plant height, stem diameter, shoot and root dry weight, stomatal conductance, photosynthesis, leaf transpiration, and water use efficiency, as well as decreases in intercellular CO2 in the leaf and vapor-pressure deficit. The enhanced biomass allocation, photosynthesis and gas exchange in MDS-supplemented plants indicates the relevant role played by this fertilizer in jatropha metabolism, resulting in more vigorous plants.Este estudo teve como objetivo comparar o crescimento e as mudanças fisiológicas em plantas jovens de Jatropha curcas L. (pinhão manso), fertilizadas ou não, com um produto comercial baseado em um sistema de fornecimento de micronutrientes (MDS), sob diferentes doses de NPK. Medidas de crescimento, teor de clorofila e troca gasosa foliar foram realizados em casa de vegetação, onde as plantas foram arranjadas em um delineamento de blocos casualizados com parcela subdividida. As plantas foram cultivadas por 120 dias em potes de 3,9 L contendo solo local, com ou sem MDS (parcela principal), combinado com doses de NPK (0; 1,8; 4,7 e 7,4 g L-1) nas subparcelas. Curvas doseresposta mostraram que a maioria das variáveis responderam positivamente às doses de NPK em plantas crescendo sem MDS, enquanto respostas fracas ou mesmo comportamento oposto foi observado em plantas fertilizadas com MDS. A aplicação de MDS em doses baixas de NPK resultaram em maior alocação de biomassa nas folhas e raízes, aumento no número de folhas e teor de clorofila, altura da planta, diâmetro do caule, pesos secos da parte aérea e raiz, condutânciaestomatal, fotossíntese, transpiração foliar e eficiência no uso da água, bem como na redução do CO2 intercelular na folha e déficit de pressão de vapor. O aumento na alocação de biomassa, fotossíntese e troca gasosa em plantas suplementadas com MDS indica o papel relevante deste fertilizante no metabolismo de pinhão manso, resultando em plantas mais vigorosas

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): study protocol for a randomized controlled trial

BACKGROUND: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). METHODS/DESIGN: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH2O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure 6430 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. DISCUSSION: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration metho